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4. Multiple Evanescent White Dot Syndrome (MEWDS) – January, 2024

Multiple Evanescent White Dot Syndrome (MEWDS) – January, 2024

History:

A 25-year-old female with no known past medical history presented with symptoms of static vision in her left eye (OS) for the past 2 weeks. She had a history of LASIK in both eyes (OU) 2 months prior to symptom onset. There was no significant family history or recent medications. Review of systems was negative.

Exam:

Visual acuity was 20/20 in her right eye (OD) and 20/60 OS. Intraocular pressure was 15 OU. Confrontational visual fields and anterior exam were normal. Her dilated exam showed a normal exam OD and small white dots 360 degrees in the periphery and venous sheathing inferonasal OS.

Figure 1: Fundus photography demonstrated the normal retina OD and multiple white dots with inferior vessel sheathing OS.

Figure 2: Ocular Coherence Tomography OCT of the macula was normal OD. OS showed disruption of the ellipsoid zone.

Figure 3: Fundus autofluorescence (FAF) showed significant hyper-autofluorescence which correlates with the white retinal dots.

Figure 4: Fluorescein angiography showed late staining of white lesions in a “wreath-like” pattern.

Differential Diagnosis:

• Multiple evanescent white dot syndrome (MEWDS)
• Acute zonal occult outer retinopathy (AZOOR)
• Punctate inner choroidopathy (PIC)
• Acute macular neuroretinopathy (AMN)
• Acute posterior multifocal placoid pigment epitheliopathy (APMPPE)
• Birdshot retinopathy

Discussion:

Multiple Evanescent White Dot Syndrome (MEWDS)

MEWDS is one of the diagnoses considered to be in the “White Dot Syndromes” category. Typically, white dot syndromes lead to yellow-white retinal lesions in the outer retina or RPE.

Patients with MEWDS are typically 15-50 years old women with unilateral photopsias, dyschromatopsia, or a temporal or paracentral scotoma. Flu-like symptoms may be present for the patient prior to ocular manifestation. FAF tends to be the most sensitive imaging modality and often picks up more lesions than visible on exam. MEWDS is a self-limiting disease that resolves in 3-9 months and no treatment is required.

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References:

1. Mirza, R., & Jampol, L. M. (2018). White Spot Syndromes and Related Diseases. In Ryan's Retina(6th ed., Vol. 2). Elsevier.
2. Jampol, Lee M. “Multiple Evanescent White Dot Syndrome: I. Clinical Findings.” Archives of Ophthalmology 102, no. 5 (May 1, 1984): 671.